April 30, 2014

Cruel But Not Unusual

How Oklahoma botched Clayton Lockett's execution

Update: According to a more detailed account of Lockett's execution, the doctor did in fact insert the IV into the prisoner's groin after an EMT was unable to find a vein in his arms and legs. The Oklahoma execution protocol provides that the doctor will insert the IV in cases where the EMT is unable to find a vein.

On Tuesday night, after Oklahoma botched the lethal injection of Clayton Lockett, the director of the Department of Corrections said Lockett’s vein had not only “blown,” but actually “exploded.” Many people immediately pointed out that Oklahoma had used for the first time a new drug combination—one of five different formulas it laid out in a new execution protocol. For all the attention that will be paid to the new drugs, though, the main problem with Lockett’s botched execution appears not to have been the drugs, but something even more basic: the needle in his arm.

While the specifics of Lockett’s case are still unclear—toxicology and autopsy reports will hopefully be forthcoming—a “blown vein” occurs when an IV catheter is either pushed through both sides of a vein or misses the vein completely, causing the drugs to flow into the surrounding tissue. As a result, the drugs don’t reach their target. In a normal medical setting, a doctor and his team will establish IV access and supervise the administration of drugs. But the death chamber is not a normal medical setting. The American Medical Association prohibits its members from participating in executions, arguing doctors’ would violate their oath to protect their patients. Nevertheless, the Oklahoma protocol requires a doctor to be on hand in a limited role to obtain instruments, to check once to make sure the prisoner is unconscious during the execution, and to pronounce death once the execution is completed. Apparently, the state was able to find a physician for this job.

The New York Times originally reported that a doctor administered all the drugs, but has since corrected its report to reflect the fact that an EMT inserted the IV and unknown persons administered the drugs, as the state's protocol requires. Bailey Elise McBride, a reporter who attended and covered the execution for the Associated Press, told me it was her understanding that “they followed protocol and the doctor was just an attending physician to monitor the inmate and his condition throughout.”

In that case, Lockett’s IV would have been inserted by an EMT or a “person with similar qualifications and experience in IV insertion,” according to the protocol. This is a harder job than you might think, especially in prisons, where inmates are often overweight and inactive, making their veins difficult to find. (Though Lockett's lawyer insisted his client "had large arms and very prominent veins.") There is little oversight of the state's selection of the individuals tasked with inserting the IV, whether they are physicians or paramedics. And this is the stage where, in the past, many executions have gone wrong. In 2006, a prisoner in Florida named Angel Diaz died a death similar to Lockett’s: After a blown vein, the chemicals pooled in his arms, causing burns. Diaz needed a second dose of drugs and took 34 minutes to die. That same year, in Ohio, Joseph Clark’s execution took 86 minutes as EMTs struggled to find a vein. In 2009, an EMT in Ohio jabbed Rommell Broom with a needle 18 times trying to establish access. His execution was eventually postponed: He walked out of the death chamber alive. At that time, Deborah Denno, a professor of law at Fordham University, told me Broom’s execution was “the worst botched execution that has happened in the history of this country.”

Lockett’s execution might have surpassed it. In all likelihood, the executioner who inserted Lockett's IV—and, in Oklahoma, an IV is inserted into both arms—missed the veins or went right through them. After this likely mistake, the state, according to the protocol, would have had “three persons to administer lethal agents”—that is, to push the drugs through the IV line. A medical professional might have been able to recognize, based on the level of resistance, that the IV line was not flowing properly into Lockett’s vein. However, the Oklahoma protocol requires no medical training at all on the part of these “three persons.” These “three persons” also could have ruptured Lockett’s blown vein further by applying too much pressure to the plunger. (It’s impossible to know who these people were. “The identities of the persons selected as executioners shall not be disclosed,” the protocol says.)

After the first drug is administered, the Oklahoma protocol requires the supervising physician to confirm that the patient is unconscious. The AP says the doctor did this 10 minutes after Lockett’s execution began. The other two drugs were then being administered when the execution team recognized a problem. Lockett started clenching his teeth and trying to lift his head. At this point, the doctor inspected Lockett and recognized the blown vein. A curtain was pulled so witnesses could not see what happened next. The Department of Corrections called off the execution and even tried to resuscitate Lockett, but it was too late: He died of a heart attack.

We will learn more about Lockett’s death in the coming days. It seems likely, though, based on the little we do know and similar cases in the past, that Lockett suffered not because the drugs did not work as they were supposed to, but rather because the people in charge of his execution made basic medical errors. The whole point of lethal injection, when it was invented, was to soften the image of capital punishment by making it look like an ordinary medical procedure. But then most medical professionals balked at participating—and so this medical procedure usually fell to people who were less qualified to perform it. States have paid great attention to which drugs they use to kill condemned prisoners—they've worried much less about finding capable persons to administer them. Of course, the drugs matter too: If Oklahoma, like some other states, had used just a large dose of a single anesthetic rather than three drugs, Lockett would likely have just felt drowsy from a blown vein. The risks are much greater with three drugs: The first drug is needed to numb the prisoner to the painful effects of the second and third drugs, so if it fails he'll suffer greatly from the other two.

The botched executions of Diaz, Clark, and Broom did not swing public opinion against the death penalty—and I’m not optimistic that the torturous death of Lockett will either. He was a particularly gruesome criminal, having murdered a girl by burying her alive, and the public is unlikely to feel much sympathy for him. And yet it is clearer now than ever that lethal injection, as it is practiced in this country, is not working as it was supposed to. “We’ve had botch after botch after botch,” Denno told me when I spoke to her for a Daily Beast article in 2009. “Since then, they’ve only gotten worse and worse. … It’s because of the setting and who’s doing it.”

Author's Note: This story was updated after The New York Times's revised its account of Lockett's execution to reflect the fact that a doctor had not inserted the IV line or administered the drugs.

Ben Crair is a story editor at The New Republic. Follow him @bencrair.